Robert Fromberg
Editor-in-Chief, HFMA
Essayist, screenwriter, and director Nora Ephron is a chronic reviser.
Here is her process: She types the first paragraph of the piece, stops, and reads it. Next she retypes that paragraph, revising as she types, and then types a second paragraph. She stops, reads the two paragraphs, then retypes them, revising as she goes, and adds a third paragraph.
She continues in this fashion until she has a complete piece, the beginning of which has been revised 20 or 30 or times, and the last paragraph of which is virtually unedited.
Ephron wrote an essay describing this process in response to an invitation to contribute to an anthology about revision. Unfortunately, Ephron’s revision process is such that she did not complete the essay until two years after receiving the invitation.
Contrast this approach to that of my grandfather, an anthropologist who wrote numerous books. I once asked him how many times he revised his manuscripts. “None,” he replied. “I sit in front of the typewriter and think about the first sentence until it is perfect. Then I type it. Then I think about the second sentence until it is perfect. Then I type it.” I hate to imagine his response should a colleague or editor suggest changing one of his “perfect” sentences.
Contrast both these approaches to the following situation. I wrote an e-mail message asking the recipient to choose one of two mutually exclusive options. The response, received 90 seconds after I sent the message, was one word: “Yep.” (I interpreted that to mean I could choose whichever option I wanted.) Too much revision was not this person’s challenge.
The drawbacks of all three examples above are obvious. So I’ll skip them. Instead, let’s look at the virtues. After all, these are three very successful people. Nora Ephron has great energy and ideas. My grandfather demonstrated a single-minded dedication to a desired outcome. And the person who provided the one-word answer showed a let’s-get-it done spirit. Imagine what it would be like to get those three people together to work toward a common goal.
As you may have guessed by now, this post is not about revision. The different approaches to revision popped into my mind as I was reading two pieces in this issue of hfm magazine. Each piece deals with the challenge of getting temperamentally different people to work together constructively--a challenge that healthcare financial executives know very well.
The April cover story in hfm magazine, “Dollars and Sense: Engaging Physicians in Supply Cost Reduction” by Jeni Williams, gives several examples of how savvy organizations are combining the clinician’s craving for clinical data and the financial executive’s craving for financial data into collaborative projects to control supply costs. And in “Bridging the Gap Between Nursing and Finance,” HFMA Chairman Joe Fifer writes about his efforts to understand the mindset of nursing by swapping roles at a recent presentation, at which Joe spoke about nurse staffing ratios while his organization’s chief nursing officer spoke about financial ratios. “The swapping of stories was more than symbolic,” Joe writes; “it represented an honest respect for each other’s role and disciplines.”
People with vastly different styles often are put in situations where they must set aside their differences to achieve the same goal--whether they be writers collaborating on a piece for publication or financial leaders and clinicians working together to ensure the success of a hospital. If Nora Ephron, my grandfather the anthropologist, and the one-word e-mailer were in a room together, there would be gnashing of teeth and rolling of eyes. But if they got beyond that stage--as has happened in the examples in this month’s magazine--the results would transcend revision.
